Vagally Mediated Bradycardia and Increased Vagal Tone: Interest of Cardiovascular Autonomic Reflexes Testing by Romani I* in Open Journal of Cardiology & Heart Diseases_ journal of cardiology & heart diseases
Abstract
Introduction: The autonomic nervous system
(ANS) controls all body functions. Dysregulation of this system may be
responsible of bradycardia. The main objective of our study is to describe the
autonomic profile of patients with bradycardia and to determine, through
testing cardiovascular autonomic reflexes its involvement in the pathogenesis
of idiopathic symptomatic bradycardia.
Material and methods: This are a retrospective study
including 72 patients with
bradycardia. The study was conducted in the ANS unit of the cardiology
department in Mohamed VI hospital of Marrakech. All patients had clinical
examination, electrocardiogram, biological exam and autonomic nervous system tests.
Results: The average age of the patients was 44 years
old with a female predominance. The mean heart rate was 50bpm. Patients had
polymorphic functional symptoms. The autonomic profile of patients with
bradycardia revealed a significant predominance of vagal hyperactivity, which
is present in 83.3% of patients. Increased vagal tone was associated with a
peripheral sympathetic alpha deficiency in 30,5% of the cases, a peripheral
sympathetic beta deficiency in 25% and even a peripheral sympathetic beta hyperactivity
in 54,1% of patients. The main autonomic syndromes found were: postural
orthostatic tachycardia syndrome (POTS) in 34,7% of patients, orthostatic
hypotension in 25% of the cases, vasovagal syncope in 8,3%, and the
baro-receptor abnormality in 12,5% of the patients. The treatment, depending on
the autonomic abnormality showed an improvement in the functional state of the
patients.
Conclusion: Autonomic profile study helps to
explain the causes of symptoms described by the patients with bradycardia whose
clinical and conventional paraclinical examinations are normal.
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